Abstract
Impaired resilience and enhanced catastrophising are characteristic of anxiety disorders, yet the mechanisms through which pharmacological interventions influence these cognitive-affective processes remain incompletely understood. Although selective serotonin reuptake inhibitors (SSRIs) are widely used as a first-line treatment for anxiety, little is known about their impact on catastrophising and resilience. While SSRIs can be a key step in therapeutic intervention plans, it is important to understand what changes these interventions evoke and how psychological constructs evolve alongside symptom improvement. This study investigated whether SSRI treatment initiation alters catastrophising and resilience in individuals with clinical anxiety and examined how changes in these constructs relate to improvements in anxiety and depression symptoms.
Using a longitudinal design, individuals initiating SSRI treatment were compared over a minimum 6-week period to individuals already stable on SSRI medication. Participants completed self-report measures assessing catastrophising (Body Sensations Questionnaire, Pain Catastrophising Scale–Respiration subscale, Pain Vigilance and Awareness Questionnaire– Respiration subscale), resilience (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Fatigue Severity Scale), anxiety (Generalised Anxiety Disorder 7 Item Scale, State-Trait Anxiety Inventory) and depression (Centre for Epidemiological Studies Depression Scale) at baseline and follow-up. Principal component analysis was used to derive latent constructs of catastrophising and resilience from the respective questionnaire batteries. Mixed-effects models were used to assess changes over time and between groups.
SSRI initiation was associated with large reductions in anxiety and depression, with substantial relative reduction in severe anxiety cases and marked categorical shifts toward subclinical functioning. At the group level, catastrophising did not show a statistically significant change following SSRI initiation, although exploratory analyses indicated a within-group reduction in the treatment group and minimal change in controls. In contrast, resilience increased significantly more in the Treatment group than in Controls, representing a large effect. Resilience levels normalised from significantly deficient baseline levels to match Control levels by follow-up. Critically, changes in both catastrophising and resilience were 2 significantly associated with reductions in anxiety and depression, indicating their relevance as potential therapeutic mechanisms or markers of treatment response.
These findings suggest that SSRI treatment rapidly enhances resilience within the initial treatment window, whereas catastrophising may require longer treatment duration or additional therapeutic mechanisms to demonstrate robust modification. By delineating these early trajectories, this study contributes novel longitudinal evidence to understanding how pharmacological treatment influences both symptom severity and broader cognitive–affective processes in anxiety.